Rush University Medical Center, Chicago, Illinois, USA.
Otolaryngol Head Neck Surg. 2012 Jun;146(6):952-8. doi: 10.1177/0194599812436952. Epub 2012 Feb 2.
To assess the need for pH testing in diagnosing laryngopharyngeal reflux (LPR).
Case series with planned data collection.
Tertiary care center.
On the basis of symptoms and/or abnormal endoscopic findings, more than 500 patients underwent 24-hour pharyngeal pH testing at a single center (using the Dx-pH probe) between January 2009 and June 2011. A total of 163 patients not on proton-pump inhibitors at the time of study and with complete data available for analysis (pH results, body mass index, smoking status, pretest reflux symptom index) were divided into 2 groups by positive (n = 70) and negative (n = 93) Ryan Score. The Reflux Symptom Index (RSI) was compared between groups and assessed overall against Ryan Score parameters at different pH thresholds. The diagnostic utility of an RSI ≥ 13 for prediction of Ryan Score was assessed.
No significant difference in RSI was seen between Ryan-positive (17.50 ± 11.47) and Ryan-negative (14.95 ± 11.43) patients (P = .161). Overall, RSI correlated poorly with percentage time spent below pH thresholds 6.5, 6.0, 5.5, and 5.0 and upright and supine Ryan parameters at these thresholds (as determined by linear regression analysis). The sensitivity, specificity, positive predictive value, and negative predictive value of RSI ≥ 13 for Ryan positivity were 55.7%, 47.3%, 44.3%, and 58.7%, respectively.
Our findings show that in our population of otolaryngology patients, the diagnosis of LPR cannot be reliably made on the basis of symptoms alone. Diagnosis, and in particular treatment decisions, should ideally be made on the basis of a combination of symptoms, signs, and confirmatory testing.
评估 pH 测试在诊断喉咽反流（LPR）中的需求。
病例系列，计划数据收集。
三级保健中心。
根据症状和/或异常的内镜发现，在 2009 年 1 月至 2011 年 6 月期间，超过 500 名患者在一个中心（使用 Dx-pH 探头）进行了 24 小时咽 pH 测试。共有 163 名患者在研究时未服用质子泵抑制剂且有完整的数据可用于分析（pH 结果、体重指数、吸烟状况、预测试反流症状指数），根据 Ryan 评分分为阳性（n = 70）和阴性（n = 93）组。比较两组之间的反流症状指数（RSI），并在不同 pH 阈值下评估总体与 Ryan 评分参数的相关性。评估 RSI≥13 对预测 Ryan 评分的诊断效用。
Ryan 阳性组（17.50±11.47）和 Ryan 阴性组（14.95±11.43）之间的 RSI 无显著差异（P=0.161）。总体而言，RSI 与 pH 阈值 6.5、6.0、5.5 和 5.0 下的时间百分比和直立及仰卧位 Ryan 参数相关性差（通过线性回归分析确定）。RSI≥13 对 Ryan 阳性的敏感性、特异性、阳性预测值和阴性预测值分别为 55.7%、47.3%、44.3%和 58.7%。
我们的研究结果表明，在我们的耳鼻喉科患者人群中，不能仅根据症状可靠地诊断 LPR。诊断，特别是治疗决策，理想情况下应基于症状、体征和确认性测试的组合。
